Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease

Abstract

SummaryBackgroundSocial determinants of health (SDOH) are becoming increasingly recognised as mediators of human health. In the setting of metabolic dysfunction‐associated steatotic liver disease (MASLD), most of the literature on SDOH relates to individual‐level risk factors. However, there are very limited data on neighbourhood‐level SDOH in MASLD.AimTo assess whether SDOH impact fibrosis progression in patients who already have MASLD.MethodsThis was a retrospective cohort study of patients with MASLD seen at Michigan Medicine. The primary predictors were two neighbourhood‐level SDOH, ‘disadvantage’ and ‘affluence’. The primary outcomes were mortality, incident liver‐related events (LREs) and incident cardiovascular disease (CVD). We modelled these outcomes using Kaplan–Meier statistics for mortality and competing risk analyses for LREs and CVD, using a 1‐year landmark.ResultsWe included 15,904 patients with MASLD with median follow‐up of 63 months. Higher affluence was associated with lower risk of overall mortality (hazard ratio 0.49 [0.37–0.66], p < 0.0001 for higher vs. lower quartile), LREs (subhazard ratio 0.60 [0.39–0.91], p = 0.02) and CVD (subhazard ratio 0.71 [0.57–0.88], p = 0.0018). Disadvantage was associated with higher mortality (hazard ratio 2.08 [95% confidence interval 1.54–2.81], p < 0.0001 for the highest vs. lowest quartile) and incident CVD (subhazard ratio 1.36 [95% confidence interval 1.10–1.68], p < 0.0001). These findings were robust across several sensitivity analyses.DiscussionNeighbourhood‐level SDOH are associated with mortality, incidence of LREs and incident CVD in patients with steatotic liver disease. Interventions aimed at disadvantaged neighbourhoods may improve clinical outcomes.

Editorial: Social determinants of health in steatotic liver disease—Generating community‐level data to maximise community impact

“…However, emerging data suggest that neighbourhood-level SDOH may affect both the development and progression of SLD. 6,7 Chen et al 8 have expanded on this work by examining the association between two well established neighbourhood-level SDOH ('disadvantage' and 'affluence') and clinical outcomes among patients with metabolic dysfunction-associated SLD (MASLD) seen at a single centre in Michigan. Increased neighbourhood disadvantage was associated with higher mortality and incident cardiovascular disease (CVD); higher neighbourhood affluence was associated with lower mortality, CVD and liver-related events (LRE).…”

Education and income are associated with long‐term outcome in the metabolic dysfunction‐associated steatotic liver disease population

“…The Five Times Sit-to-Stand Test is part of a short physical performance battery (SPPB) and is widely used to evaluate physical performance. 1,2 In this test, the time required to complete five consecutive rises from a chair is measured, and this action is performed as swiftly as possible, without arm assistance. As this test relates not only to self-reported disability but also to functional outcomes, [1][2][3] it is also used to diagnose sarcopenia.…”

“…1,2 In this test, the time required to complete five consecutive rises from a chair is measured, and this action is performed as swiftly as possible, without arm assistance. As this test relates not only to self-reported disability but also to functional outcomes, [1][2][3] it is also used to diagnose sarcopenia. [4][5][6] There are two different approaches to time the Five Times Sit-to-Stand Test: From a seated position, the test ends either in a fifth standing position (fifth stand) or in another fifth seated position (fifth sit).…”

“…Education and income are associated with long-term outcome in the metabolic dysfunction-associated steatotic liver disease population Dear Editor, Previous studies have demonstrated that lower education and income levels independently increased the risk of liver steatosis. 1,2 Nonalcoholic fatty liver disease (NAFLD) is a liver condition that too much fat accumulated in the liver in subjects who drink little to no alcohol. Recently, the Delphi Consensus proposed a new nomenclature for NAFLD, namely metabolic dysfunction-associated steatotic liver disease (MASLD).…”

Screening for social determinants of health among populations at risk for MASLD: a scoping review

“…Data from the Centers for Disease Control and Prevention show higher prevalence of diabetes among non-White racial/ethnic groups; ( 10 ) based on national data, obesity is associated with lower household income and lower education level ( 16 ). Although the direct relationship between SDoH and MASLD is less well-studied, emerging evidence has shown that education ( 5 ) and race/ethnicity ( 4 ) are associated with MASLD prevalence and severity, neighborhood-level SDoH is associated with mortality, complications and cardiovascular disease, ( 26 ) and food insecurity is associated with increased risk of advanced liver fibrosis and all-cause mortality among those with MASLD ( Figure 1 ) ( 2 , 24 , 27–30 ).…”